健脾化瘀汤对内镜下大肠腺瘤切除术后复发的影响

目的：探讨健脾化瘀汤对内镜下大肠腺瘤切除术后复发的影响。方法将60例内镜下大肠腺瘤切除术后患者采用随机数字表法分为2组，每组30例。大肠腺瘤切除术后，观察组服用健脾化瘀汤，对照组不再进行其他治疗。2组均于大肠腺瘤切除术后1年复查肠镜，记录腺瘤数目、大小，以及大肠黏膜环氧合酶-2(cyclooxygenase-2, COX-2)、Ki67表达值的变化并进行评分，比较2组试验前后COX-2、Ki67表达阴转情况。结果观察后，观察组腺瘤数目(0.20±0.48)分比(1.67±1.54)分，t＝4.980]、腺瘤大小(0.23±0.57)分比(2.73±2.80)分，t＝4.788]评分，COX-2(1.96±1.27)分比(3.64±1.95)分，t＝3.673]、Ki67(2.04±1.46)分比(4.50±1.73)分，t＝5.558]表达值评分均低于对照组(P＜0.01)；观察组COX-2、Ki67表达阴转例数分别为21例、22例，高于对照组的12例(P＝0.004)、14例(P＜0.001)。结论健脾化瘀汤可降低大肠腺瘤切除术后的复发率，其作用机制可能与下调COX-2、Ki67表达有关。

The study of clinical effect and mechanism on Jianpi-Huayu decoction preventing against ;recurrence of colonic adenoma after endoscopic mucosal resection

Objectives To observe the effect of Jianpi-Huayu decoction for preventing the patients from the recurrence of colonic adenoma after endoscopic mucosal resection. Methods A total of 60 patients with colonic adenoma who received endoscopic mucosal resection were divided randomly into the experimental group (taking Jianpi-Huayu decoction) and the controlled group (taking nothing as treatment), 30 patients in each group. Both groups were treated for 1 year. After 1 year, colonscopy was taken, and the number and size of colonic adenoma were recorded. The expression of COX-2, Ki67 in the colonic mucosa were detected the immunohistochemistry, and the negative rate of COX-2, Ki67 were also detected. Results After the treatment, the number (0.20 ± 0.48 vs. 1.67 ± 1.54, t=4.980) and size (0.23 ± 0.57 vs. 2.73 ± 2.80, t=4.788) of colonic adenoma in the experimental group were statistically lower than those in the ontrolled group (P<0.01);the expression of COX-2 (1.96 ± 1.27 vs. 3.64 ± 1.95, t=3.673) and Ki67 (2.04 ± 1.46 vs. 4.50 ± 1.73, t=5.558) in the the experimental group were statistically lower than those in the ontrolled group (P<0.01). The number of the paitents whose COX-2, Ki67 negative rates in the experimental group were 21 and 22, and the control group were 12(P=0.004) and 14 (P<0.001), which showed the significant difference between two groups. Conclusions The Jianpi-Huayu decoction could reduce recurrence of colonic adenoma after endoscopic mucosal resection, the mechanism was decreasing the expression of COX-2, Ki67 in colonic mucosa.